Advanced Gestational Age Research Articles

Factors associated with the prevalence of periodontal disease in low-risk pregnant women

ObjectiveTo evaluate the prevalence of periodontal disease (PD) among Brazilian low-risk pregnant women and its association with sociodemographic factors, habits and oral hygiene.MethodThis cross-sectional study included 334 low-risk pregnant women divided in groups with or without PD. Indexes of plaque and gingival bleeding on probing, probing pocket depth, clinical attachment level and gingival recession were evaluated at one periodontal examination below 32 weeks of gestation. Independent variables were: age, race/color, schooling, marital status, parity, gestational age, smoking habit, alcohol and drugs consumption, use of medication, presence of any systemic diseases and BMI (body mass index). Statistical analyses provided prevalence ratios and their respective 95%CI and also a multivariate analysis.ResultsThe prevalence of PD was 47% and significantly associated with higher gestational age (PR 1.40; 1.01 - 1.94 for 17-24 weeks and PR 1.52; 1.10 - 2.08 for 25-32 weeks), maternal age 25-29 years, obesity (PR 1.65; 1.02 - 2.68) and the presence of gingival bleeding on probing (ORadj 2.01, 95%CI 1.41 - 2.88). Poor oral hygiene was associated with PD by the mean values of plaque and bleeding on probing indexes significantly greater in PD group.ConclusionsThe prevalence of PD is high and associated with gingival bleeding on probing, more advanced gestational age and obesity. A program of oral health care should be included in prenatal care for early pregnancy, especially for low-income populations.

Cornual Molar Ectopic Pregnancy: A Case Report with Difficult Management in Poor Resources Settings

Molar pregnancy is a rare entity and ectopic location of pregnancy in the uterine horn represents the least frequent site of implantation. This paper presents a rare case of molar cornual ectopic pregnancy at advanced gestational age with a particular difficulty in diagnosis and management. A 35-year-old woman, gravida 4 para 3 with a history of 12 weeks amenorrhea, was operated for presumed ruptured ectopic pregnancy. Per-operative findings showed swollen villi in clusters that looked like bunches of grapes, characteristic of a complete hydatiform mole, located at the left horn of the uterus. Histopathologic examination confirmed the diagnosis. Bleeding could not be controlled with suturing and hysterectomy was eventually done. Although rare, molar pregnancy can be ectopic. If it is located at the uterine horn, bleeding may be difficult to control if at a gestational age of 12 weeks or more.

Utility of Diagnosing Various Histological Patterns of Diffuse Chronic Hypoxic Placental Injury

To examine the clinicopathologic correlations of three histological patterns of diffuse chronic hypoxic placental injury (preuterine [PR], uterine [UH], and postuterine [PU]), a retrospective statistical analysis of a large 14-year placental database was performed. Of 5097 placentas between 20 and 43 weeks of gestation examined consecutively, 4413 did not feature histological chronic placental hypoxia, while 684 did. In the latter, maternal hypertensive disorders, diabetes mellitus, abnormal cardiotocography and Dopplers, cesarean sections, inductions of labor, and fetal growth restriction, as well as other placental hypoxic lesions and decidual arteriolopathy, were statistically significantly more common than in the remaining placental material. Two hundred eighty-nine PR cases featured the most advanced gestational age and meconium staining; 237 UH cases featured severe preeclampsia, decidual arteriolopathy, villous infarction, membrane laminar necrosis, microscopic chorionic pseudocysts, excessive extravillous trophoblasts, and maternal floor multinucleate trophoblastic giant cells; and 158 PU cases featured the lowest placental weight and the highest prevalence of abnormal Dopplers, umbilical cord compromise, fetal growth restriction, cesarean section rate, and complicated 3rd stage of labor. The specificity of chronic hypoxic patterns of placental injury was much higher than the sensitivity, with the highest specificity for an excessive amount of extravillous trophoblasts. Diagnosing various hypoxic patterns of placental injury by histology may help to clarify the etiopathogenesis of a significant proportion of complications of pregnancy and abnormal fetal or neonatal outcomes. The patterns should help to retrospectively diagnose placental hypoxia, even in clinically unsuspected cases.

Prenatal Weight Gain: Who is Counseled?

Because prenatal counseling is associated with adherence to weight gain guidelines, we sought to identify patient-level characteristics associated with the receipt of counseling on weight gain, nutrition, and exercise during prenatal care. We performed a secondary data analysis on a cohort of women enrolled in a prenatal counseling intervention study. We controlled for study group assignment (intervention versus usual care) as well as patient characteristics in a multivariable analysis. We performed three separate multivariable analyses for predictors of provider-patient discussions about (1) weight gain, (2) nutrition, and (3) exercise. The cohort consisted of 311 predominantly low-income prenatal patients receiving care at several sites in the San Francisco Bay Area. Prepregnancy body mass index, nutrition knowledge, maternal age, parity, and type of insurance were not significantly associated with receipt of counseling about weight gain, nutrition, and exercise. In the multivariable analysis, white women were significantly less likely to be counseled about nutrition than non-white women (p=0.02). Former smokers were more likely to receive counseling about nutrition and exercise than never smokers (p<0.05). More advanced gestational age was associated with a higher rate of counseling on weight gain (p=0.01). Despite having the highest rates of excessive weight gain nationally, white women were the least likely to receive counseling about nutrition during pregnancy. Interventions that prompt clinicians and simplify counseling may improve counseling rates for all patients during prenatal care.

Heterotopic Pregnancy

Review the clinical presentation, diagnosis, and minimally invasive management of heterotopic pregnancy. Case Report and Clinical Review. University-affiliated Non-Profit Physician Organization. Second trimester IVF patient presenting with an acute abdomen. Laparoscopic treatment of ruptured second trimester ectopic pregnancy as a component of heterotopic pregnancy. Heterotopic pregnancy, in which two gestations coexist at two different locations- usually an ectopic tubal pregnancy with a simultaneous intrauterine pregnancy, occurs naturally in one out of every 30,000 pregnancies. The incidence is considerably higher in pregnancies conceived with Assisted Reproductive Technology, estimated at 1.5 of every 1000 ART pregnancies. In recent years the overall incidence of heterotopic pregnancy in the United States has risen to 1:3900. A case report of a second trimester heterotopic IVF pregnancy with tubal rupture is herein described, managed laparoscopically with maternal preservation but an ultimate adverse outcome for the surviving intrauterine twin. The diagnosis of heterotopic pregnancy is reviewed and management options discussed. Heterotopic pregnancy presents a diagnostic challenge for clinicians and consequently is often diagnosed at a more advanced gestational age, not infrequently with tubal rupture and maternal hemodynamic instability. Because of the serious potential consequences for maternal and neonatal health, the possibility of heterotopic pregnancy should be considered with high risk pregnancies. The ART pregnancy should be identified as such when requesting ultrasound studies, and the ultrasonographer should carefully screen the pelvis for a concomitant ectopic gestation. Once the diagnosis of heterotopic pregnancy is made or strongly suspected, intervention should be as timely and minimally invasive as possible, to protect the coexisting intrauterine pregnancy and prevent serious maternal morbidity.

Clinical use of a model to predict the viability of early intrauterine pregnancies when no embryo is visible on ultrasound

When a small gestational sac with no visible embryo is seen at an early pregnancy ultrasound scan, the clinician cannot distinguish a viable from a non-viable pregnancy. A test for the prediction of early pregnancy viability at the initial visit was developed in 2003. Maternal age, gestational sac diameter (GSD) and serum progesterone levels were used in a logistic regression model to create an algorithm for estimation of the probability of a viable pregnancy. The objective of this study was to assess how well the test performed in routine clinical practice. This is a retrospective observational study of women who had the test performed in our Early Pregnancy Unit over a 6-year period. Inclusion criteria were a spontaneous conception, gestational sac of <20 mm mean diameter, no visible embryo on transvaginal ultrasound scan and outcome data regarding the viability of the pregnancy. Of 5163 potentially eligible women, 472 had the test performed (9.1%) and 400 met the inclusion criteria for the study. Women who were older or with vaginal bleeding, a more advanced gestational age or a history of previous first trimester miscarriages were more likely to have the test performed. At follow-up, 199/400 (49.8%) women had a viable intrauterine pregnancy, and 201/400 (50.2%) had a non-viable pregnancy. The logistic regression model performed better than serum progesterone, β-hCG, mean GSD or maternal age alone as single parameters to differentiate between viable and non-viable pregnancies, but the area under the curve was lower than in the 2003 study [0.85 (standard error 0.021) versus 0.97 (standard error 0.011)]. Although less effective than in the original study, the logistic regression model was able to predict pregnancy viability with reasonable accuracy when applied in clinical practice. The test appears to be under utilized and further prospective studies are needed to establish if the test is of clinical benefit, for example, in reducing patient anxiety.

P15.14: Echographic diagnosis of cervical teratoma at an advanced gestational age

P15.14: Echographic diagnosis of cervical teratoma at an advanced gestational age

Cerclage cervical en urgence au deuxième trimestre de la grossesse : expérience clermontoise

Objectives The objective of this study was to identify factors associated with favourable perinatal outcome after emergency cervical cerclage during mid-trimester of pregnancy. Patients and methods This is a retrospective study of all cases who underwent emergency cervical cerclage between 16 to 28 weeks of gestation (WG) over a period of 16 years in a University Hospital. Results Among the 32 cases, the postnatal survival rate (day 28) was 80%. Delivery occurred at a mean gestational age of 33.1 WG [18–41.3 WG] and after 37 WG in 39% of cases. The perinatal outcome was improved by absence of bleeding ( P = 0.01), unripened cervix ( P = 0.02), cervical dilatation below 2 cm ( P = 0.002), no protruding membranes ( P = 0.02) and more advanced gestational age at the procedure ( P = 0.005). When no uterine contraction and no maternal blood inflammation were observed at admission, an expectancy of 48 hours before the procedure did not improve significantly perinatal outcome (gestational age at birth and survival rate [ P = 0.1 and P = 0.3 respectively]). Discussion and conclusion Perinatal outcome after emergency cerclage depends on cervical status and gestational age at procedure. It is not influenced by an expectancy of 48 hours before intervention for patients with no uterine contraction and no maternal blood inflammation at admission.

Role of four‐dimensional ultrasound (spatiotemporal image correlation and Sonography‐based Automated Volume Count) in prenatal assessment of atrial morphology in cardiosplenic syndromes

To assess the diagnostic role of four-dimensional ultrasound using spatiotemporal image correlation and Sonography-based Automated Volume Count (STIC-SonoAVC) in the identification of the morphology of the atrial appendages in cases with cardiosplenic syndrome. This was a retrospective investigation of 22 fetuses with cardiosplenic syndromes seen at our institution over a 5-year period from January 2004. As control groups, 10 normal fetuses, five cases with a non-isomeric atrioventricular septal defect and five cases with other congenital heart diseases were also analyzed. For all fetuses, one or more cardiac volume datasets were available for offline analysis. Two-dimensional and four-dimensional echocardiography was carried out in all cases at the time of diagnosis using high quality three-dimensional equipment. Dedicated software was used to assess chamber morphology using the SonoAVC technique, which allows the creation of casts of hollow structures. Two different operators used the software. The first performed all steps up to positioning of the region of interest box. The second operator, who was blinded to clinical information, then rendered the cardiac chambers using the SonoAVC technique. This operator then used the rendered image to subjectively assess atrial morphology. Suitable rendered images of the cardiac chambers could be produced in 40/42 fetuses. In two cases of left atrial isomerism, advanced (34 weeks) and early (13 weeks) gestational age made it impossible to obtain adequate rendered images. In the remaining 40 cases (13 cases of left atrial isomerism, seven cases of right atrial isomerism, five cases of non-isomeric atrioventricular septal defect, five cases of other congenital heart diseases and 10 normal fetuses), atrial morphology was correctly identified by evaluation of the rendered images. Four-dimensional ultrasound with SonoAVC rendering allows correct identification of the morphology of atrial appendages in all cases of cardiosplenic syndromes in which an adequate cardiac volume dataset can be obtained for analysis.

Evaluation and management of severe preeclampsia before 34 weeks' gestation

We sought to review the risks and benefits of expectant management of severe preeclampsia remote from term, and to provide recommendations for expectant management, maternal and fetal evaluation, treatment, and indications for delivery. Studies were identified through a search of the MEDLINE database for relevant peer-reviewed articles published in the English language from January 1980 through December 2010. Additionally, the Cochrane Library, guidelines by organizations, and studies identified through review of the above documents and review articles were utilized to identify relevant articles. Where reliable data were not available, opinions of respected authorities were used. Published randomized trials and observational studies regarding management of severe preeclampsia occurring <34 weeks of gestation suggest that expectant management of selected patients can improve neonatal outcomes but that delivery is often required for worsening maternal or fetal condition. Patients who are not candidates for expectant management include women with eclampsia, pulmonary edema, disseminated intravascular coagulation, renal insufficiency, abruptio placentae, abnormal fetal testing, HELLP syndrome, or persistent symptoms of severe preeclampsia. For women with severe preeclampsia before the limit of viability, expectant management has been associated with frequent maternal morbidity with minimal or no benefits to the newborn. Expectant management of a select group of women with severe preeclampsia occurring <34 weeks' gestation may improve newborn outcomes but requires careful in-hospital maternal and fetal surveillance.

Two logistic models for the prediction of hypothyroidism in pregnancy.

BackgroundThe mounting evidence linking hypothyroidism during pregnancy with poor pregnancy outcome underscores the need for screening and, therefore, a search for more reliable and cheaper screening methods. MethodsThe study was conducted in two phases. The phase one study comprised of healthy women in different stages of pregnancy who attended routine antenatal clinic at St Theresa's Maternity Hospital, Enugu, Nigeria from September 6 to October 18 1994. In this study the variables compared between the hypothyroid and non-hypothyroid pregnant women were maternal age, the number of the pregnancy or gravidity, gestational age, social class, body weight, height, the clinically assessed size of the thyroid gland, serum free thyroxin (FT4) and serum thyrotrophin (TSH). Based on the parameter differences between the two comparison groups of pregnant women two Logistic models, Model I and Model 11, were derived to differentiate the hypothyroid group from their non-hypothyroid counterparts. The two logistic models were then applied in a prospective validation study involving 197 pregnant women seen at presentation in Mother of Christ Specialist Hospital and Maternity, Ogui Road, Enugu from March 2002 to November 2007FindingsThe findings were that 82 (50.3%) of the 163 pregnant women had thyroid gland enlargement while 60 (36.8%) had hypothyroidism as defined by FT4 values below and/or TSH above their laboratory reference ranges. The pregnant subjects with hypothyroidism, compared with their non-hypothyroid counterparts, were characterized by a higher gravidity (p < 0.01), a higher body weight (p < 0.01), a higher goiter prevalence rate (p < 0.01) and a more advanced gestational age (p < 0.0001). A significant, positive correlation was also found between body weight and gestational age (r = 0.5; p < 0.01) At the cut-off point for Model l (fitted with gravidity, thyroid size and gestational age) it had a sensitivity of 100%, a specificity of 72.8% and an overall predictive accuracy of 82.9%; whereas for Model II (fitted with gravidity, thyroid size and body weight) the sensitivity was 100%, the specificity was 59.2% and the overall accuracy of discrimination was 74.8%. In the prospective validation study both models showed a sensitivity of 100% each with specificities of 85.5% for Model I and 76.2% for Model II.ConclusionIt is concluded that logistic models fitting gravidity, thyroid gland size and gestational age or body weight are useful alternatives in screening for hypothyroidism during pregnancy. There is, however, a need for further independent confirmation of these findings.

Trichorionic Quadruplet Delivered Beyond 36 Weeks of Gestation: A Case Report and Literature Review

Following one year of secondary fertility, a couple conceived with a quadruplet after transfer of three embryos through IVF-ICSI. At 36 weeks and 2 days of gestation, the mother developed gestational induced hypertension and delivered the next day by caesarean section. Pathology confirmed the zygosity to be trichorionic quadramniotic and all four babies were discharged home with their mother on postoperative day 3. Herein, we describe a successfully managed high-risk pregnancy case. A review of the literature was conducted and to our knowledge no other cases with similar criteria ever reached such advanced gestational age.

Relationship between prenatal care and the outcome of pregnancy in low-risk pregnancies

Introduction: This study was conducted to evaluate the relationship between prenatal care and outcome of pregnancy. Method: This is a cross-sectional study on 210 pregnant women referring to Afzalipour Hospital for their labor, consisting of 140 women with adequate care and 70 with inadequate care. The outcome of pregnancy for mother and newborn was compared between the two groups. Data were analyzed using SPSS software version 15. P value ≤ 0.05 was considered as significant and the power of statistical test was 80%. Findings: The findings indicate that the age of women with inadequate care was lower compared to those receiving adequate care (p = 0.003). Furthermore, women with inadequate care had lower education (p = 0.00007) and their prenatal care started in more advanced gestational ages (p = 0.0003). Neonates born to women with inadequate care tended to have lower birth weights (p = 0.05) and higher rates of admission to NICU (p = 0.02). Conclusion: Our findings indicate that women with lower age and education received less prenatal care and adequate prenatal care results in better birth weights and decreased rate of admission in NICU.

A case series of 46 appendectomies during pregnancy

Among appendicitis patients pregnant ones occupy only a small proportion. Still there are difficulties in the diagnosis and management of the acute appendicitis in pregnant population. We tried to find answers to these difficulties with our acute appendicitis cases in pregnant patients. This study involved 46 pregnant patients who received an operation following diagnosis of acute appendicitis in our clinic from 2006 to 2009. Data were collected retrospectively from medical records. Age, time delay to diagnosis, leukocyte count (WBC), gestational age, gestational history, morbidity-mortality and pathology results were evaluated. The mean age of patients, gestational age and number of prior pregnancies were 26, 21 and 2.6, respectively. The amount of time spent in the hospital, from presentation of first symptom to admission, was approximately 40 hours (range 6-120). The mean time from admission to operation was 5.89 (range 1-32) hours. The perforation rate among our cases was 21%. The negative appendectomy rate was 13%. The perforation rate was associated with advanced gestational age and delayed admission to the hospital (p ≤ 0.001 and p = 0.027, respectively). The diagnosis of appendicitis in pregnancy is difficult, and the perforation rate is high. Particularly in term pregnancies, we recommend performing appendectomy immediately after cesarean section.

Neurodevelopmental outcomes of very low birth weight and extremely low birth weight infants at 18 months of corrected age associated with prenatal risk factors

Background Very premature infants occasionally have neurodevelopmental disabilities. However, there have been quite limited data on prenatal risk factors associated with their neurodevelopmental outcomes. Aim To clarify the relationship between prenatal risk factors and neurodevelopmental outcomes of very premature infants. Study design The study design is a retrospective review. Subjects One hundred seventy Japanese women with a singleton pregnancy and their infants whose birth weight being less than 1500 g were included. We classified those infants into 118 appropriate for gestational age (AGA) and 52 small for gestational age (SGA) infants. Outcome measures Infants' neurodevelopmental outcomes at 18 months of corrected age were evaluated by the Kyoto Scale of Psychological Development 2001 (KSPD). We analyzed and compared the infants' outcomes and prenatal risk factors between two groups. Results Mortality and rate of infants unevaluable by KSPD because of severe impairment were not significantly different between those groups. However, the developmental quotient score of the cognitive–adaptive area in SGA infants born between 25 and 31 weeks of gestation was significantly lower than that in AGA infants randomly selected as gestation-matched controls. More advanced gestational age and heavier birth weight protected against adverse neurodevelopmental outcomes in both groups. Moreover, male infants were related to the excess risk of adverse neurodevelopmental outcomes in the SGA group. Conclusion In view of the neurodevelopment of the infants, it seems that the most efficient obstetric strategy for improving prognosis of premature infants should be targeted to prolong the pregnancy period as long as the reassuring fetal status and maternal stable health condition are being confirmed.

1201 Respiratory Syncytial Virus Prophylaxis in Special Populations

Objective: To determine palivizumab utilization in infants with pre-existing disease within the Canadian Registry Database (CARESS). Methods: A prospective registry of infants from 27 sites who received palivizumab during the 2006-2009 RSV seasons. Demographic data were collected from the parent/caregiver at enrollment. Data on palivizumab utilization, compliance, and outcomes related to respiratory infection (RI) events were collected monthly. Infants ≤35 weeks gestational age (GA) who met current approval criteria (Group 1) were compared to those with medical disorders who received off-label palivizumab (Group 2). Results: Group 1 (n=3379) Group 2 (n=489). Male: 56.9% vs 54.9% (P=0.43). Average Enrollment Age (months) ± SD:3.6 ± 3.4 vs 9.9 ± 8.8 (P=0.00). Average GA (weeks) Mean ± SD: 31.0 ± 3.1 vs 37.1 ± 4.3 (P=0.00). Average # injections ± SD:3.6 ± 1.5 vs 3.7 ± 1.5 (P=0.16). Hospitalization Rate (HR) for RI:4.1% vs 9.2% (P=0.00). RSV HR: 1.0% vs 2.2% (P=0.04). Compliant injections: 67.6% vs 67.6% (P=0.99) Group 2 infants comprised Down syndrome (n=118, 24.1%), upper airway anomalies (n=112, 22.9%), cystic fibrosis (n=62, 12.7%), neuromuscular impairment (n=42, 8.6%), pulmonary (n=38, 7.8%), multiple system disorders (n=34, 7.0%), cardiac (n=17, 3.5%), immunocompromise (n=8, 1.6%), and miscellaneous (n=58, 11.9%). The proportion of Group 2 infants receiving prophylaxis increased from 5.6% (69/1224) to12.2% (245/2016). Group 2 infants were older at enrollment with more advanced GA and had significantly higher RI and RSV hospitalization rates. Conclusion: Clinicians strongly advocate for palivizumab in special populations based on perceived morbidity and mortality risk and evolving evidence from small cohort and case-controlled studies.

3D and 4D sonography and magnetic resonance in the assessment of normal and abnormal CNS development: alternative or complementary

Advanced transvaginal neurosonography has revealed normal and abnormal intracranial morphology. Transvaginal three-dimensional (3D) sonography demonstrates bony structure, multiplanar analysis of inside detailed morphology, tomographic ultrasound imaging in any cutting sections, 3D sonoangiography and volume calculation of ventricles and/or intracranial lesions. Longitudinal assessment of normal and abnormal central nervous system (CNS) development is done by serial scanning. However, the transvaginal high-frequency approach has several limitations due to lack of penetration and cranial bone ossification with advanced gestational age. Magnetic resonance neuroimaging enabled observation of the whole intracranial cavity, brainstem and cortical gyral/sulcal development. On the other hand, neuro-sonography has advantages in detecting intracranial calcification, vascular abnormalities, intratumoral vascularity and bone dysplasia. Moreover, 3D ultrasound demonstrates extra CNS abnormalities, strongly associated with CNS abnormalities. Any less-invasive modalities can be used for a CNS anomaly screening scan and ultrasound is no doubt the first choice. Once CNS abnormality is suspected, it is suggested to use the different technologies according to what is looked for in each abnormal CNS case. Of course, MR and 3D ultrasound imaging should be complementary as well as alternative.

Aplicação de programa educativo multidisciplinar em gestações de alto risco devido a doenças endócrinas

to investigate the application of a multidisciplinary educational program to high-risk pregnancies due to endocrine diseases. we retrospectively evaluated the application of a multidisciplinary educational program to 185 pregnant women with endocrine diseases referred to a maternity specialized in high-risk pregnancy. All pregnant women received multidisciplinary prenatal care from a team consisting of endocrinologists, obstetricians, sonographers, nurses and dietitians. Oral and written information about healthy habits, diabetes care, use of artificial sweeteners and exercise during pregnancy was given to all patients at the first endocrine consultation. An individualized nutrition plan was prepared on the occasion of the first visit to the nutritionist. In bi-weekly and monthly endocrine and nutritional visits, respectively, information about healthy changes in lifestyle was emphasized and the weight was recorded. Adherence to physical activity and nutritional counseling was self-reported. We compared the weekly weight before and after the intervention, fetal weight at birth, rate of macrosomia and low birth weight, and frequency of cesarean delivery among the four categories of body mass index (BMI) before pregnancy (<18.5, from 18.5 to 24.9, from 25 to 29.9 and >30 kg/m²). the main disease of referral was diabetes (84.9%). One third of the pregnant women (31.2%) were overweight and 42.5% were obese before pregnancy. Most women was first seen by the multidisciplinary team in the third trimester of pregnancy (64.1%) and 50.5% exceeded the recommended weight gain at first evaluation. Obese women exceeded the recommended weight gain in 62.5% of cases. After the intervention, the percentage of women who exceeded the recommended weekly weight gain was reduced in all categories of pre-pregnancy BMI, although a statistically significant difference was found only in the group with normal pre-pregnancy BMI (40.6 versus 21.9%, p = 0.03). At birth, average fetal weight was similar among the various BMI categories (p=0.277). Macrosomia was more frequent in women who were overweight and obese before pregnancy. Cesarean delivery was the most frequent route of delivery, regardless of pre-pregnancy BMI. in high-risk pregnancies due to endocrine disorders, a multidisciplinary educational approach limits excessive weekly weight gain despite the advanced gestational age.

Estimate of the attenuation coefficient using a clinical array transducer for the detection of cervical ripening in human pregnancy

Premature delivery is the leading cause of infant mortality in the United States. Currently, premature delivery cannot be prevented and new treatments are difficult to develop due to the inability to diagnose symptoms prior to uterine contractions. Cervical ripening is a long period that precedes the active phase of uterine contractions and cervical dilation. The changes in the microstructure of the cervix during cervical ripening suggest that the ultrasonic attenuation should decrease. The objective of this study is to use the reference phantom algorithm to estimate the ultrasonic attenuation in the cervix of pregnant human patients. Prior to applying the algorithm to in vivo human data, two homogeneous phantoms with known attenuation coefficients were used to validate the algorithm and to find the length and the width of the region of interest (ROI) that achieves the smallest error in the attenuation coefficient estimates. In the phantom data, we found that the errors in the attenuation coefficients estimates are less than 12% for ROIs that contain 40 wavelengths or more axially and 30 echo lines or more laterally. The reference phantom algorithm was then used to obtain attenuation maps of the echoes from two human pregnant cervices at different gestational ages. It was observed that the mean of the attenuation coefficient estimates in the cervix of the patient at a more advanced gestational age is smaller than the mean of the attenuation coefficient estimates in the cervix of the patient at an earlier gestational age which suggests that ultrasonic attenuation decreases with increasing gestational age. We also observed a large variance between the attenuation coefficient estimates in the different regions of the cervix due to the natural variation in tissue micro-structures across the cervix. The preliminary results indicate that the algorithm could potentially provide an important diagnostic tool for diagnosing the risk of premature delivery.

Determinants of immediate complications of abortion: A study done in Mekane Hiwet Maternity Hospital.

Objective: to identify the main determinants associated with immediate complications of abortion. The determinants (factors) studied were: delay in arrival to the hospital, delay in starting treatment, type of onset of abortion (induced or spontaneous), gestation at onset of abortion, age, marital status, literacy and parity. Design: A cross sectional descriptive study Setting: Mekane Hiwet Maternity Hospital, Asmara, Eritrea Subjects: 368 patients admitted to the hospital with the diagnosis of abortion during a 3-month study period (June 1st to August 31st of 2003) Outcome measure: the proportion of early complications of abortion namely, heavy bleeding and infection. Results: The main determinant factors identified to be associated with early complication of abortion were: inducing the abortion (50% versus 21%), advanced gestational age at onset of abortion (31.9% versus 20.5%) and being unmarried (38.25 versus 20.2%). Furthermore it was found that when abortion was induced, it was being induced at an advanced gestational age making a deadly combination of the two risk factors. Conclusion: The finding is in consistency with most studies on abortion done in Africa calling for a remedial action to be taken to avert the need of inducing abortion unsafely and give the necessary post abortion care for the victims.